| NPI | 1275645400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 9801459) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35C.003153) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NC 9801459) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: MS 25504) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WV 27514) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR E-11057) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 56055) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2026-04-27 |